Frequently Asked Questions Regarding Your Fertility Treatment

1. Frequently Asked Questions Regarding Your Fertility Treatment

2. What is the volume of ejaculate that can be termed as adequate? As per WHO 2010 guidelines, volume below 1 mL is termed as Hypospermia. However, we have observed good count and motility in samples even below 1mL. So, please do not stress about producing an adequate quantity of sample. However, many a time patients mistake pre-ejaculate for ejaculate. Your andrologist will be trained to tell you the difference and may ask you to produce another sample on a later day if the sample that has been produced does not suffice in anyway.

3. If I am unable to produce the sample at the clinic, can I collect the sample from home or a nearby hotel? Yes, you may bring the sample from home if 1) you collect the sample in the sterile container provided by the clinic 2) you reach the clinic in 30-40 minutes post collection. Also, your clinic may require you to sign a form of consent declaring that the sample bought from home is your own.

4. Can I collect the sample in the sterile container provided by the pathology lab? Containers provided by the pathology lab are sterile BUT meant for urine collection so it may be difficult for you to collect semen in them. Containers provided by fertility clinics are specifically designed for semen collection.

5. Do I need to come fasting for semen analysis, semen freezing, or semen wash? Absolutely not, please follow your normal routine. In fact, have a good breakfast or lunch to maintain your energy levels.

6. Why are there variations between my semen analysis reports done at a pathology lab and a fertility lab? Most pathology labs use glass slides to check the semen count. Fertility clinics use a special counting chamber called the Makler or Neubers chamber, specifically meant for checking the sperm count and motility, and it is therefore more accurate.

7. Can I collect my semen in a condom? Commercial condoms have lubricants which are spermicidal. Therefore, it is not advisable to use them. There are special condoms available for the collection of semen samples and can be procured on request.

8. What should I do if I spill the sample? Please inform the andrologist immediately. Do not collect the sample and put it in the container. The idea is to use sterile sample for your procedure to avoid infection.

9. How do you prevent samples from getting mixed up at the lab? Each container is well-labelled and as a practice only one sample is handled at a time

10. What do you do with the left-over sample after analysis? The samples are discarded as per protocol.

11. How should the sample be collected? The sample should ideally be collected by masturbation. If you suffer from penile erectile dysfunction or any other related problems, please inform the consultant.

12. Does medication, smoking, and alcohol affect the semen parameters? Yes, they do influence the semen parameters. However, it is also something that varies between individuals, and a semen analysis is required to assess the severity in a case.

13. I did a semen analysis last month and repeated another analysis this month at the same clinic. There is a variation in my result. Is this normal? It is normal to see a slight variation between tests.

14. Is there a report for semen analysis or freezing that should be given to us? Reports are made for all ART procedures and as patients, please ask your clinic for written reports of the same.

15. Do I need to have a full bladder while collecting the sample? There are no restrictions on the bladder.

16. I took 40 minutes to collect the sample. Will that impact the count? The time you take to collect the sample is irrelevant; the time is noted at the collection of the sample.

17. Can I be asked to produce another sample on the same day? It is uncommon, but you may be asked to collect an additional sample if the andrologist feels that: => The count is inadequate in comparison to your previous tests. => you have spilled the sample.

18. If my sample has a good count of sperms but the sperms have no motility, does it mean they are all dead? Immotile does not necessary mean dead. Sperms can have no motility but they may still be viable to induce pregnancy. There are tests available to determine the difference.

19. If the success rate for IUI is lower than that of ICSI, why should I not go for an IVF cycle directly? Depending on the investigation done by doctors, it may be deduced that you may only require a little help through IUI to achieve pregnancy. Also, the cost and number of injections to be taken for an IVF cycle are higher.

20. What causes abnormal fertilization? Abnormal fertilization can be caused by many factors – poor quality oocyte or sperm or in some cases, two sperms may have entered the oocyte, but that phenomenon is rare in ICSI as only a single sperm is injected.

21. I have been told that from 12 mature eggs only 2 eggs got fertilized. Is that low? Yes, it is low. Normal fertilization rates are usually 70%. This may be more prevalent in semen samples with low morphology or women with Polycystic Ovary Syndrome (PCOS) where the number of oocytes is high but the quality is poor.

22. I was told there has been a “fertilization failure.” What does that mean? This means that there has been no fertilization. This may be due to extremely poor sperm or egg quality. Please consult your embryologist and clinician for more treatment options.

23. If abnormal fertilization is not separated from normal, how will it impact my results? Abnormal PN may arrest or progress into beautiful embryos, but if transferred these embryos can cause miscarriages and have a higher probability of becoming an abnormal baby.

24. Why is it important to wait for the follicle size to grow to 18-20 mm before the trigger? Evidence has shown that only follicles with sizes of 18-20 mm have mature oocytes. Follicles, if retrieved at a smaller size may have immature oocytes.

25. My OPU was done on Saturday, and the fertilization check will fall on a Sunday. Will it still happen? No, years of research have shown that if the oocytes had to, they would have shown the signs of fertilization between 16-19 hours. So, keeping them for additional hours will not help.

26. I had only one mature egg, and that lone egg is showing 3PN (abnormal). Can we grow it further and transfer it to the uterus? It takes both the egg and the sperm to make good embryos. Speak to your clinician and the embryologist about the reason for the low-quality of the embryos.

27. On Day 2, my clinician told me I have four B grade embryos. Later on Day 3, I got a call saying that I have two B, one A and one C grade embryos. Which one should I believe? You need to believe both. The grade is dynamic and changes every day. That is why it is important to understand that had you opted for a Day-2-transfer, you would have picked any of the two B grade embryos in their cleavage stage after which it would grow and float in the uterus for two days until it becomes a blastocyst and then implants.

28. All embryos have to progress up to the blastocyst stage before they can implant and culminate in pregnancy. But now, on Day 3, you have discovered that the Day-2-embryo is not necessarily a good one. Waiting for Day 3 thus gives you: More information Better embryo selection Better embryo to transfer

29. Does paternal age have an impact on Semen? Paternal Age does not have an impact on count, motility and morphology. However, there may be an increase of DFI (DNA fragmentation index) in such patients.

30. Does paternal age have an impact on Semen? Paternal Age does not have an impact on count, motility and morphology. However, there may be an increase of DFI (DNA fragmentation index) in such patients.

31. Why is oocytevitrification done? Oocytevitrification is done in the following cases: Social: Absence of the male partner so the female may want to preserve her fertility Fertility preservation before taking toxic drugs for treatment like cancer. Only mature oocytes are vitrified after denudation

32. How is vitrification done? Vitrification is done by washing the oocytes or embryos in media within a stipulated time. Once the washing is completed the embryo or eggs are loaded on a loading device and submerged immediately into liquid nitrogen. They are stored in liquid nitrogen at all times (-196)

33. How many embryos or oocytes can be frozen on one straw? The number of embryos depends on the stage of their development: Cleavage stage – embryos: No more than three embryos should be vitrified per straw Blastocyst stage – Since their diameter is larger, no more than two should be vitrified on one straw For oocytes – No more than four oocytes should be frozen on one straw

34. I vitrified three embryos last year? Can we check how they are doing? Once vitrified, we will know about their survival only when they have been thawed for the procedure. Though, if vitrified. properly they will remain in the same state or grade for years.

35. Does vitrification have a harmful effect on the embryos? They are similar to the fertilization rates in fresh oocytes.

36. I have been married for two years, and I want to preserve my fertility as it is now to have babies later. Should I freeze my embryos? If you are married, have a male partner but wish to postpone pregnancy, I would recommend you freeze your embryos.

37. Twenty eggs were retrieved, but my clinic told me only 12 were vitrified. Why? Only mature oocytes after denudation are vitrified. Immature oocytes are discarded; that is probably why your clinic has frozen only 12 MII.

38. If I have vitrified my embryos today and you thaw them after one year, how will you know that you are thawing my embryos? Each straw which contains embryos is labelled meticulously with your name and ID. Documentation is very important in an embryology lab.

39. I have been informed that my straw contains three embryos. Can I remove two embryos from the straw and return the straw back to the tank? No, once the straw is thawed, all embryos will have to be removed. We don’t have the option of removing one or two embryos from the straw. However, you may discuss the option of refreezing the embryos with your embryologist and clinician.

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